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Gallstones, a very prevalent issue has arisen in modern society as a result of lifestyle changes, the intake of junk food, and irregular eating patterns. The development of these stones usually starts in the gall bladder and sometimes these stones start coming upwards towards the common bile duct along with the secretion of bile during the digestion process. Usually, there is no onset of symptoms and these issues are sometimes mistaken for indigestion, which is a transient condition but if the size of the gallstones increases in number and size for an extended period, then this leads to the severity and might worsen the condition of the patient is not detected early.

What are Gall bladder and Gallstones?

The gall bladder is a little, pear-shaped structure situated beneath the liver on the upper right side of the belly. It holds the bile that the liver produces for digestion and releases it into the duodenum through the bile duct. Water, cholesterol, bile salts, and pigments like bilirubin and others make up this bile. The breakdown of lipids in our bodies is aided by bile.

          Gallstones or Cholelithiasis which originate in the gallbladder or bile ducts is solid masses resembling pebbles made of bile precipitates. They range in size from the size of golf balls to small sand grains. Gallstones are usually of two different types:

1.  Cholesterol stones- 80% of the gallstones are of this type and these are usually yellowish-green in color.
2. Pigment stones- these gallstones are usually smaller and darker in color. The color of these gallstones is determined by the excess production of the bile pigment bilirubin produced by the liver.

What are the causes? – There is no exact cause for the occurrence of gallstones, still, some of the causes which lead to the formation of gallstones are listed below:

1. Due to a bad lifestyle such as extreme junk food consumption rich in cholesterol regularly, skipping meals or eating irregularly, severe consumption of alcohol and smoking, etc.
2. Excess production of the bile pigment bilirubin by the liver in cases of cirrhosis, other liver disorders, and blood infections.
3. Self-medication like regular intake of NSAIDs to relieve chronic pain.
4. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach. This condition usually leads to ascending the gallstones towards the common bile duct from the gall bladder and finally results in obstructive jaundice due to the blockage at the bile duct.
5. People over the age of 40 years, obese or overweight, and diabetic people are at higher risks for cholelithiasis.

What are the common symptoms observed?-

1. Sudden intense abdominal pain usually at the upper right portion usually right after the consumption of meals.
2. Vomiting
3. Indigestion, gas formation, and heartburn.
4. Pain in the right shoulder, between the shoulder blades, or towards the back.
5. Jaundice-like symptoms like yellowing of the skin and white portion of the eye.
6. Dark-colored red urine and pale stool.
7. Fever and chills
8. Loss of appetite
9. Severe complicated causes include inflammation of the gall bladder (Cholecystitis), Pancreatitis, and inflammation of the bile ducts (Cholangitis).

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such as Blood tests and urine culture.
2. Upper abdomen ultrasonography- it is a non-invasive test to check the location of the gallstones. However, only large-sized gallstones and the stones present in the gall bladder are visible in this diagnostic test. Smaller-sized gallstones like pigment stones and the gallstones present in the bile ducts are undetected, thus it is not an accurate test.
3. An MRI technique called Magnetic Resonance cholangiopancreatography (MRCP) especially visualizes the bile ducts. It produces highly detailed images of our biliary system including the common bile duct and is non-invasive. MRCP provides a clear picture and also rules out the possibility of tumors or cancer. Depending upon the number, size, and location of the gallstones, the doctor finally decides which surgical procedure needs to be performed on the patient for the removal of the gallstones.
4. Endoscopic retrograde cholangiopancreatography (ERCP) is a more advanced and more non-invasive procedure that is effective in locating gallstones if any of them are lodged in the ducts and can also be removed using this technique. It is very useful in the detection of smaller-sized pigment gallstones. It employs a combination of X-rays and endoscopy which entails inserting a small camera into the upper gastrointestinal (GI) system through the mouth.
5. What is ERCP?

ERCP is both diagnostic as well as a therapeutic technique for gallstones which consists of an endoscope inserted through the mouth with an attached camera that passes through the food pipe and reaches the top of the small intestine, then the technician inserts another smaller tube into the first one to reach further down into the bile ducts. They will inject a special dye through the tube and then the video X-rays (fluoroscopy) are taken as the dye travels through the ducts. Through ERCP, a clamp-like tool is inserted through the tube to remove the stones which are present in the duct. The large-sized gallstones are removed by lithotripsy in which the gallstones are first crushed or broken down into smaller pieces and then each piece is taken out through the scope. The 190 series ERCP (Endoscopic Retrograde Cholangiopancreatography) is cutting-edge technology in the earliest identification of biliary tract neoplasm, cholangiocarcinoma, and pancreatic ductal adenocarcinoma.
 

• Endoscopic Ultrasound- this combines both ultrasound and ERCP for the detection of gallstones.

Cholecystectomy- is laparoscopic keyhole surgery for the removal of the gall bladder when the gallstones are accumulated in this sac. It is an ICG Enhanced Fluorescence Guided procedure that requires a small incision, high resolution, minimal blood loss, and a very low risk of infection.

• Medications as prescribed by the medical practitioner.

Prevention and Control-

1. Avoid consumption of oily, fried, and spicy foods.
2. Intake of a healthy diet rich in high- fiber such as fruits, vegetables, and whole grains.
3. Consuming several little meals throughout the day.
4. Reduction of alcohol consumption and caffeine.
5. Management of stress.
6. Maintaining a healthy weight, exercising, etc.

Liver is the second largest organ in the body which produces bile and helps to process the nutrients from food and drinks, further it filters the harmful substances from the food. Liver also helps to resist the infections by removing toxins and bacteria from the blood.

There is a modest amount of fat in a healthy liver. When fat equals 5% to 10% of your liver's weight, it becomes an issue. Steatosis, also known as fatty liver disease, is a common disorder brought about by an accumulation of too much fat in the liver.

Fatty Liver condition isn’t bad until and unless the condition becomes worse and reaches the stage when there is inflammation in the liver (steatohepatitis) along with the extensive damage of liver tissues (cirrhosis). The liver's function starts slowing down by the tough scar tissue that has replaced the healthy liver tissue and eventually the functioning of the liver completely stops. Severe cirrhosis can lead to Liver failure and Liver cancer.

Stages of Fatty Liver-

1. Normal Fatty Liver- excess fat accumulation in the liver due to higher levels of cholesterol. This condition is also known as Simple Fatty Liver.
2. Steatohepatitis- this occurs when along with the fat accumulation in the liver leads to inflammation. This condition is a bit severe than the previous one.
3. Fibrosis- Along with the inflammation, slowly scarring and damage of the liver tissues occur. In this condition, the liver still functions normally.
4. Cirrhosis- This is the most severe and irreversible condition where the scarring of liver tissues starts affecting the liver functions.

What are the causes? –

1. Due to bad lifestyle such as extreme junk food consumption rich in cholesterol at regular basis, skipping meals or eating irregularly, severe consumption of alcohols and smoking etc.
2. Overweight and obesity
3. Due to physical and mental stress
4. Self- medication like regular intake of NSAIDs to relieve the chronic pain
5. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach.

What are the common symptoms observed?-

1. Abdominal pain especially in the upper right side of the abdomen.
2. Nausea
3. Edema- Swollen abdomen and legs.
4. Bloating
5. Loss of appetite.
6. Jaundice- Yellowish skin and white portion of the eyes.
7. Unexplained weight loss
8. Fatigue

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such Blood tests and urine culture.
2. Upper Gastrointestinal tract endoscopy- An endoscope is a lengthy, thin tube with a camera attached inserted from the mouth and passes through the food pipe and gives the images till the upper part of the small intestine.
3. Upper abdomen ultrasonography or CT Scan to check the possibility of epigastric hernia or suspicion of any abnormality in the digestive tract.
4. Liver biopsy- this is done by collection of the liver tissue samples to check the progression of the disease.
5. FibroScan- this is a more advanced and specialized ultrasound which is done instead of liver biopsy and tells the total amount of fat accumulation in the liver and finds out the scarred liver tissues.
6. Medications as prescribed by the medical practitioner.

What is FibroScan?

Transient elastography, another name for fibroscan, gauges the velocity of ultrasound waves as they pass through the liver. The normal liver tissue and the areas of fibrosis are both viewed by the ultrasound waves' varying velocity. FibroScan results are available right away after the scan. It is a non- invasive test and used to determine the degree of fibrosis in the liver. This is even done to assess the health of the liver.

Prevention and Control-

1. Avoid consumption of oily, fried and spicy foods.
2. Consuming a number of little meals throughout the day.
3. Reduction of alcohol consumption and caffeine.
4. Management of stress.
5. Avoid resting down for two to three hours immediately after a meal.

Adults frequently complain of joint pain, which is typically brought on by regular wear and tear from daily activities including walking, bending, standing, and lifting. Running and sports involving jumping or fast pivots increase the risk of knee pain and other related issues in athletes. But whether joint pain is brought on by ageing or an injury, it can be bothersome and even crippling in some cases.

Common joint pain typically manifests in the hands, foot, hips, knees, or spine. Pain may be ongoing or intermittent. Joint pain can sometimes be described as discomfort, inflammation, soreness, stiffness, or pain. Joint discomfort can be acute (lasting only a few days) or chronic (lasting more than three months). The joint may occasionally feel stiff, achy, or sore. A searing, throbbing, or "grating" feeling is reported by some patients and furthermore the joint could be stiff in the morning but get looser and feel better with activity.

What are the causes of orthopedic joint pain? 

1. Sprained or strained knee ligaments or muscles- Those who have had any joint injuries or repeated overuse of the muscles.
2. Another cause of stiffness and painful joints is age. This results in the strain and wear and tear of the joints.
3. Osteoarthritis- a prevalent type of arthritis which develops over time when the cartilage (the protective cushion in between the bones) wears away and the joints start to hurt and stiffen. It is a degenerative disease that progressively worsens with age and is irreversible.
4. Torn cartilage which occur with sprains.
5. Joint dislocation due to injury or accident.
6. Rheumatoid arthritis- A persistent condition that injures the joints and causes swelling. This results in the deformation of joints (usually occurring in the fingers and wrists).
7. Gout- Crystals from the body build up in the joint which results in excruciating pain and swelling. Usually, the big toe experiences this.
8. Due to physical and mental stress

What are the common symptoms observed?-

1. Intense pain
2. Swelling of joint, redness and fever
3. Difficulty in walking
4. Joint inflammation and cartilage decay due to arthritis
5. Reduced mobility and joint stiffness
6. Numbness
7. Noisy joints like clicking, grinding or crackling sound during movement.
8. Visible deformity of the affected joint

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such as Blood tests, hormone tests, tests to detect the function of adrenal glands and Urine culture.
2. X-rays, CT scan or MRI scan.
3. Arthroscopy- A minimally-invasive diagnostic and treatment procedure used for joint conditions. A tiny, illuminated optic tube introduced through a tiny incision in the joint. Images of the inside of the joint are projected onto a screen in order to analyze any arthritic or degenerative changes in the joint, to find tumors, to identify the source of bone pain and inflammation. This procedure is also used for ACL (anterior cruciate ligament) surgery.
4. Replacement surgeries like Total Knee Replacement, Total Hip Replacement, Spinal surgeries to relieve the unbearable pain and also adds new shelf life to the joints. This is usually suggested for severe osteoarthritic patients.
5. Physiotherapy as suggested by the physician for post-operative patients and also suggested exercises for restoring movement to the numb joint.
6. Medications as prescribed by the medical practitioner.

What is Total Knee/ Hip Replacement surgery?-

It could be challenging to walk or climb stairs if the knee or hip joint has been seriously affected by arthritis or another accident. So, even while sitting or lying down, one could start to experience pain. Replacement surgery is recommended for the patients with bowed knee deformity. The average surgical procedure lasts between 1-2 hours and requires very less hospital stay for about three days. After three to six weeks of rest, the patient can resume back to his daily routine. To correct the alignment and function of knee/hip joint, the orthopedic surgeon will remove the damaged bone and cartilage and then places the new metal implants which are made up of titanium dioxide highly polished with cobalt chromium. These implants mimic the exact the knee/ hip joint and offers the same movement as that of a natural joint. These replacement surgeries do not have any age or weight restrictions and can be performed at any stage of the life. Having a knee/hip replacement surgery improves mobility, reduces pain, and improves the quality of life. Additionally, the majority of these replacements provide a shelf life longer than 15 years.

Prevention and Control-

1. Activity modification such as weight loss.
2. Walking aids such as walking sticks, safety bars, or handrails across the staircases for those with disrupted movement.
3. Viscosupplementation injections and nerve ablation for immediate pain relief. Viscosupplementation involves injecting a gel-like fluid called hyaluronic acid which provides lubrication and may provide immediate pain relief. But this procedure has not been found to be effective and often causes side effects like redness, and swelling in the injected part and may develop a local allergy-type reaction.
4. Avoid using low-floor toilets and the use of western commodes is recommended.
5. Physiotherapy exercises for restoring the movements and strengthening the joint post-operation.
6. Management of stress.

Nowadays with the change in lifestyle, consumption of junk food, eating irregularly has led to a very common problem among us – gastric problems such as stomach pain, loss of appetite, bloating, and nausea. These gastric problems arise due to inflammation in the mucosal lining of the stomach, any bacterial infections such as Helicobacter pylori etc. Sometimes these problems are often confused with indigestion which is temporary but prolonged infection in the gastrointestinal tract can lead to severity of the diseases if not detected at the earliest.

What are the causes? –

1. Bacterial infection- which causes the destruction of the stomach cells and leads to peptic ulcers.
2. Due to bad lifestyle such as extreme junk food consumption at regular basis, skipping meals or eating irregularly, severe consumption of alcohols and smoking etc.
3. Due to physical and mental stress
4. Self- medication like regular intake of NSAIDs to relieve the chronic pain
5. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach.

What are the common symptoms observed?-

1. Abdominal pain
2. Vomiting
3. Bloating
4. Loss of appetite.
5. Unexplained weight loss
6. Blood in the stool
7. Stomach ulcers

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such Blood tests and Stool tests for the detection of the pathogen.
2. Upper Gastrointestinal tract endoscopy- An endoscope is a lengthy, thin tube with a camera attached inserted from the mouth and passes through the food pipe and gives the images till the upper part of the small intestine.
3. Upper abdomen ultrasonography to check the possibility of epigastric hernia or suspicion of any abnormality in the digestive tract.
4. Medications as prescribed by the medical practitioner.

Prevention and Control-

1. Avoid consumption of oily, fried and spicy foods.
2. Consuming a number of little meals throughout the day.
3. Reduction of alcohol consumption and caffeine.
4. Management of stress.
5. Avoid resting down for two to three hours immediately after a meal.

Dengue is a vector-borne disease transmitted by an infected female mosquito of the Aedes aegypti species that causes high fever. These mosquitoes are different from normal mosquitoes with white bands present on their legs. It often bites during the day and after the infected mosquito bites a human, the symptoms start developing in the body within 3-14 days. It has been seen that dengue infects children more.

Dengue Fever has the following symptoms:

1. High fever usually around 104 °F.
2. Severe headache
3. Rashes

4. Pain behind the eyes
5. Intense muscle and joint pain
6. Loss of appetite
7. Fatigue

Tips to prevent Dengue:

1. Avoid water stagnation in coolers, open areas, containers etc. By pouring a thin layer of kerosene oil over the stagnated areas to prevent the breeding of mosquito larvae.
2.  People are advised to wear full sleeves clothes to prevent transmission in the rainy season.
3. Mosquitoes frequently hang around in damp, dark areas. Make sure that there is plenty of sunlight in the room or house to keep mosquitoes out. Additionally, camphor may destroy many kinds of pests, so a smoky candle can be lighted every other day for roughly 30 minutes in the room.
4. As dengue mosquitoes usually bite during the daytime, it is advised to use a mosquito net while sleeping during the day and mosquito repellents in the form of roll-ons, sprays and sticks should be used.
5. Use aerosol during the day to prevent mosquito bites.

Diagnosis and Treatment:

1. Complete blood count test was done which gives information about platelet status, Dengue NS1 antigen, nucleic acid detection by PCR, etc...
2. Blood transfusions for platelets in severe cases as the platelet count eventually drop in dengue patients.
3. Though there are no antiviral medicines to treat dengue fever, early diagnosis and clinical treatment can help the patients.
4. Those suffering from dengue are advised to keep themselves hydrated.

This day is celebrated in remembrance of French biologist Louis Pasteur who gave the first dose of the first vaccine against the zoonotic disease rabies. This day holds importance in promoting awareness and educating people about the zoonotic diseases that can be transmitted from animals to the humans.
          Zoonoses, also known as zoonotic diseases, are infectious conditions caused by microorganisms that can pass from animals to humans. These zoonotic pathogens, which can be bacterial, parasitic, viral, or even strange agents, can spread through direct or indirect contact between animals and humans.

Causes- Zoonotic diseases are caused by a number of factors. Some of them are:
1. Direct contact- due to bites, scratches, or ingesting bodily fluids including blood, saliva, urine, faeces, or bite wounds from an infected animal.

2. Indirect contact: This might happen in areas where sick animals feed or live and are infected by the zoonotic pathogens.

3. Foodborne: Due to consuming contaminated foods like as raw fruits and vegetables, milk, meat, eggs coming from infected animals.

Symptoms-

1. Flu like symptoms like fever, cough, headache, fatigue and bodyache.
2. Visible lesions of bite marks, scratches on the skin.
3. Abdominal cramps, vomiting, severe diarrhea and loss of appetite.

Diagnosis and Treatment-

1. Physical examination of the skin
2. Administration of antibiotics and vaccines in case of animal bites.
3. Wear masks or protective clothing those who have animal allergy.
4. Periodic blood tests to identify the pathogens in order to start the medications.

Prevention and Control-

1. Vaccinate the pet animals immediately before getting them home.
2. Immediate administration of vaccines or medicine in case of animal bites or scratches.
3. Increasing knowledge of zoonotic diseases and operationalization among the people globally.
4. Improve biosecurity and identify the main causes of zoonotic disease in livestock.
5. Improving the zoonotic disease regulation and monitoring.
6. Make alternative livelihoods and ensure food security while promoting sustainable agricultural technology.

On June 27, 1995, the first National HIV Testing Day (NHTD) was observed. This is a day to encourage people to get tested for HIV, learn their status, and connect with care and treatment.

The theme for 2022, "HIV Testing is Self-care," is apt, given the importance of self-care during the COVID-19 pandemic

This year’s theme focuses on the following goals for partners.

• Testing is key to ending the HIV epidemic.
• Taking the test is taking care of yourself.
• Taking care of our loved ones too!
• Taking care of the wellness of the society

It's also very important, considering the crucial necessity of individual and community initiatives to improve physical and mental health.

What is HIV AND why HIV Testing is necessary?

Human immunodeficiency virus (HIV) is a virus that targets the body's immune system, which serves as its natural protection against sickness. If HIV is not treated, it might weaken the immune system to the point that it can no longer fight infection. Early testing helps to prevent this advanced stage of the virus, known as AIDS, is lethal and can be prevented.

HIV is a life-threatening disease that can infect people of all ages, genders, and sexual orientations.  Up to one in every seven persons living with HIV remain unaware of their status.

The test is quick and simple: During an HIV test, doctors collect a blood or saliva (swab test) sample for analysis. In about 20 minutes, you'll know if you have the infection. An HIV test is free.

If your HIV test results indicate that you have the virus, you can get the therapy you need to stay healthy. Antiretroviral medications now allow HIV patients to live long and normal lives.

 When you know your HIV status, you can take precautions to safeguard current and future sexual partners, as well as encourage former partners to be tested.

This day is celebrated in remembrance of Michael Jackson who suffered from vitiligo and died on 25^th June, 2009 to create global awareness about vitiligo. It encourages unity among the people with vitiligo to rule out the discrimination faced by them by the people and raise their voices and visibility in all the areas of life. Over 1% of the total world population suffers from vitiligo where it affects all the genders and ethnic groups especially in the age groups of 20-30 years.

Causes- Vitiligo is an autosomal disease that causes the loss of skin pigment cells called melanocytes. This causes the skin to lighten in patches across the body and face. It is often unpredictable but children born to both parents having this disease are more likely to develop vitiligo. This is non-communicable disease and around 80% of the people develop this condition before the age of 30 years.

Symptoms-

1. Depigmentation of the hair, skin and eyes.
2. Patch on the skin with no color especially on the inside of the mouth.
3. Premature graying of hair on the scalp and eyebrows.
4. Light sensitivity
5. Change in color of the eye’s retina.
6. Freckles and moles with light pinkish color due to reduced pigment.

Diagnosis and Treatment-

1. Physical examination of the skin
2. Electroretinogram for detect of light sensitivity in the eyes associated with vitiligo.
3. Micro-pigmentation also called permanent make up, is a tattooing procedure to treat vitiligo.
4. Protective sunglasses, clothing and sunscreens to protect from the UV exposure.

Genetic counseling to understand the inheritance of vitiligo in the family history.

Sickle cell anemia is the most common inherited blood disorder which causes “sickle” shaped red blood cells in humans. These deformed blood cells stick with each other, blocks the blood flow and oxygen to reach the other parts of the body. This day is observed annually with the goal to increase public knowledge and an understanding of sickle cell disease, and the challenges experienced by patients and their families.

This sickle cell mutation occurs when negatively charged glutamine is replaced by a neutral valine at the sixth position of the beta-globin chain and this mutation is transmitted and is inherited by an autosomal co-dominant fashion. People suffer from severe pain and has to be treated with strong painkillers like morphine. Symptoms of sickle cell start showing from around 5 to 6 months of age and along with the pain a person can also suffer from anemia, swelling in the hands and feet, bacterial infections, blindness, bone damage and stroke.           The only available treatment to the sickle cell anemia is the stem cell transplantation. Genetic counseling is very vital to understand the possibility of inheritance of sickle cell anemia in the family history. Periodic checkups with the doctor is very crucial for the people suffering with sickle cell anemia to check the blood hemoglobin, Red Blood Cells counts etc.

Menstruation or menses is the monthly shedding of the lining of a woman’s uterus. It is also known as the menstrual period, cycle or period. The menstrual blood is composed of blood and tissue from the endometrium of the uterus and flows through the cervix and out of the body through the vagina. The average menstrual cycle is 28 days long and can range in length from 21 days to about 35 days. The menstrual cycle is triggered by hormones controlled by the pituitary gland in the brain and the ovaries in the female reproductive tract. Girls start menstruating at the average age of 12 and as early as 8 years of age or as late as 16 years of age. Women stop menstruating at menopause, which occurs at about the age of 51.

Significance of National Menstrual Hygiene Day:

1. It aims to bring together the people for promoting good menstrual health and hygiene for everyone around the world.
2. To break the silence, raise awareness and change the social stigmas around menstrual health and hygiene.
3. It provides an opportunity to engage decision-makers and increase the political priority to catalyse the actions for menstrual health and hygiene at global, national, and local levels.

Tips to maintain Menstrual Hygiene:

1. Change the sanitary pads regularly to avoid the conditions like Toxic Shock Syndrome (bacterial infection) and other infections.

2. Maintain cleanliness and hygiene.

3. Choose the correct method of sanitation.

4. Wash yourself regularly.

5. Consult a gynaecologist immediately if any discomfort or infection arises.

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